The Construction And Implementation Of Clinical Pathway Based On Integrated Traditional Chinese And Western Medicine For Patients With Diabetic Peripheral Neuropathy

BackgroundDiabetic Peripheral Neuropathy is one of the most common chronic complications of diabetes, and its morbidity can reach as high as 60% to 90%. Typical symptoms include clinical manifestation of acroagnosis and neural motor function deficits, and EMG manifesting the surrounding neural sensory and motor function deficits. This disease has long course, and is of high disability rate, and hard to cure, thus severely affects the life quality of patients. Because of lack of specific drug, and the influence of the safety of the medicine to the treatment, there is apparent limit in the treatment of this disease now. Modern medicine has not yet offer exact guide to the treatment of DPN, despite of deep research of its pathogeny and general accepted knowledge and theory, there is no effective way to treat this disease. Strictly controlling the blood sugar is a basic method to prevent DPN, but to those patients who develop the disease for a certain time, it is not totally effective, and may have the possibility of severe hypoglycemia. So, it must be explored to find more effective methods, on the basis of strict control of blood sugar. Prophase clinic researches by Chinese medicine have proved that it has certain effect on treating DPN, but further researches have to be conducted on how to normalize the treatment to improve the curative effect. Literature review have prompted that the pathogeny can be concluded as taking Qi and Yin deficiency as root, phlegm blocking the collaterals is all through the course of disease. The characteristics of the Chinese medicine treatment of DPN include:1. Chinese medicine is in unification in the syndrome differentiation treatment, and the choosement of medicine and formulas.2. External treatment plays an important role in treating DPN, and is paid a lot of attention. It emphasizes on the internal and external, which is the feature of the treatment.With the consistent development of Chinese medicine research, its distinctive advantage has grown. Because of the complexity of the disease, many experts in the medical area have realized that the method of combing is the most effective method.Object ives1. To formulate and perfect the treatment of DPN by methods of combination of Chinese medicine with Western medicine2. To establish a set of optimized solution of the treatment of DPN, which is absolutely effective, easy to conduct, and with reasonable fee.3. To reveal the features and keys of the Chinese medicine treatment of DPN, thus to provide clinic evidence that will push the objectification and standardization of Chinese medicine treatment effect evaluation.MethodsThis thesis, by literature research, experts consultation, consensus research, and retrospective cases study, and applying the concepts of EBM to establish the solution of the treatment of DPN by methods of combination of Chinese medicine with Western medicine, as well as conducting retrospective and foresight researches in the 11 research center in our country at the same time, making use of Epidata, SPSS17.0 to manage and statistics the date of researches, evaluates the clinic effect, fee and time of being in hospital, and further to analyze the influential factor of clinic effect and time of being in hospital, and the changeable situation of clinic conduct.ResultsThis thesis, by literature research, experts'consultation, consensus research, and retrospective cases study, concludes the Chinese medicine's law of treating DPN, which is to ensure the name of disease of excessive drinking and urine, muscularrheumatism, combination of syndrome differentiation and disease differentiation treatment, and primary symptoms with accompanied symptoms, as well as methods of benefiting Qi and nourishing Yin, promoting blood circulation and removing blood stasis, with combination of Western medicine achievement, establish clinic treatment solution. Foresight researches find that on the basis of improving the clinic effect, the fee of being in the hospital has lowered, without prolonging the time of being in the hospital. Setting the time of being in the hospital as reference, patients are divided in two groups:those who leaves the hospital earlier and later. By comparison, the improvement of primary symptom in Chinese medicine and the symptoms in Western medicine, can show the effect of clinic treatment. Blood sugar control, Chinese medicine rate in the treatment of disease, whether having Merger diabetic retinopathy, whether having increase in Hemorrheology determination, whether coming to doctors in time have difference(P<0.05). According to the results of changeable situation in clinic conduct, the condition of patients, the personal judgment and habits of doctors and nurses, and the compliance of patients are the main parts in the changeable situation of this conduct.Conclusion1. The establishment of combination of Chinese medicine with Westetn medicine to treat DPN is strongly scientific and reasonable.2. The improvement of primary symptom in Chinese medicine and the symptoms in Western medicine can be used as reference of the clinic effect.3. Blood sugar monitor conduct situation, good blood sugar control and good Chinese medicine both internal and external can shorten the time of being in the hospital.diabetic retinopathy DR, Hemorrheology learn determination, and coming to doctors in time all influence the time of being in the hospital.4. The condition of patients is main reason of leaving hospital earlier, later, increasing paths and the check in non set paths.the personal judgment and habits of doctors and nurses, and the compliance of patients are the main parts in the changeable situation of this conduct.